Thymoglobulin and Rate of Infectious Complications After Transplantation

Clesca, Paul; Dirlando, M.; Park, S.-I.; Garcia, Ricardo M; Ferraz, E.; Pinheiro-Machado, Paula G.; Kushnaroff, L.; Tedesco‐Silva, Hélio; Medina-Pestana, J.O.

doi:10.1016/j.transproceed.2007.01.024

Cited by 35 publications

(29 citation statements)

References 8 publications

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“…Use of thymoglobulin more than 7 mg/kg has been associated with more frequent infectious complications (6).…”

Section: Discussionmentioning

confidence: 99%

“…Brennan et al(3) presented that thymoglobulin is better than basiliximab for high risk patients, reduced acute rejection rate and severity (3)(4)(5). However the usual dose of thymoglobulin (7∼10 mg/kg) may contribute to increase risk of infectious disease or malignancy (6). Even low-dose thymoglobulin reduced risk for acute rejections and maintained better kidney function by 3 and 5 years fol- low-up than basiliximab (7).…”

Section: Introductionmentioning

confidence: 99%

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Optimal Dose of Thymoglobulin for Induction Therapy in High Risk Kidney Transplant Recipients

Kim

Kang

Park

et al. 2016

Korean J Transplant

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Background: Thymoglobulin has been used for induction therapy to prevent acute rejection and delayed graft function (DGF) in kidney transplant patients. However, the usual dose of thymoglobulin is considered to be related with frequent infection. We compared the efficacy and safety of low-dose thymoglobulin to high-dose treatment in high risk recipients with kidney transplantation.Methods: Twenty-one kidney transplant recipients underwent induction treatment with thymoglobulin and were divided into two groups: patients treated with low-dose (＜6.0 mg/kg) and high-dose thymoglobulin (≥6.0 mg/kg). All patients showed one or more risk factors for acute rejection or DGF. The risk factors were re-transplantation, recipient or donor age over 60 years, human leukocyte antigen full mismatch, and panel-reactive antibody more than 50%. We compared incidence of acute rejection, infection, hematologic complications, and graft survival between two groups.Results: The demographic characteristics of the two groups were comparable. Mean follow-up duration was 11.9±4.3 months, and cumulative thymoglobulin dosage was 6.3±1.6 mg/kg. The incidence rates of acute antibody-mediated rejection (AMR), DGF and infectious events as cytomegalovirus disease, or urinary tract infection were not significantly different between the two groups. Neutropenia occurred more frequently in the high-dose thymoglobulin group, but there was no statistically significant difference.The rate of graft loss were similar between the two groups.Conclusions: There were no differences in graft survival, infectious disease, and hematologic problems between the two groups. We suggest to lower the dose of thymoglobulin to less than 6 mg/kg for prevent acute AMR and DGF in high risk patients.

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“…Use of thymoglobulin more than 7 mg/kg has been associated with more frequent infectious complications (6).…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Optimal Dose of Thymoglobulin for Induction Therapy in High Risk Kidney Transplant Recipients

Kim

Kang

Park

et al. 2016

Korean J Transplant

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“…Another approach would be to reduce the dose by monitoring peripheral CD3 levels and adjusting the dose of rATG [14]. A reduction in total does of rATG will result in substantial cost saving and decreased incidence of infectious complications as the complication rate increased when the total dose of rATG was higher than 7 mg/kg [16]. …”

Section: Discussionmentioning

confidence: 99%

Outcomes in African-Americans vs. Caucasians Using Thymoglobulin or Interleukin-2 Receptor Inhibitor Induction: Analysis of USRDS Database

Jindal

Das²,

Neff³

et al. 2008

Am J Nephrol

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Aim: We used the USRDS database to test the hypothesis that graft survival was similar using either rabbit antithymocyte globulin (rATG) vs. interleukin-2 receptor inhibitor (IL2i) in the Prograf era. We further explored the variable of race in the two groups of patients. Methods: We conducted a retrospective cohort study of kidney transplant patients in the USRDS from 2000 through 2005 to compare graft survival (including death) using rATG vs. IL2i with particular reference to outcomes between African-Americans vs. Caucasians. Kaplan-Meier analysis was performed to assess patient and graft survival after transplantation, stratified by recipient induction with rATG versus IL2i. Cox regression analysis was performed to assess adjusted survival after transplantation, assessing whether induction rATG (vs. IL2i) was significant as an interaction term (i.e. an effect modifier) with black race for graft survival. Propensity score analysis was used to address potential confounding by indication. Results: In stratified Cox Regression analysis limited to IL2i, black race was significantly associated with graft loss (adjusted hazard ratio (AHR) 1.17, 95% CI, 1.09–1.26). In analysis limited to rATG induction, black race was not significant (AHR 1.00, 95% CI, 0.92–1.10). We detected a significant interaction between rATG and black race (in comparison with non-black race) for the development of graft loss (AHR, 0.86, 95% CI, 0.76–0.97). Analysis limited to black recipients showed that while use of rATG was not significantly different from IL2i (AHR 0.95, 95% CI 0.87–1.04), the direction of this association was in the opposite direction of non-blacks. Conclusions: Patient and graft survival were similar in African-American and Caucasian recipients of kidney transplantation using either rATG or IL2i. Limitations of the study are the retrospective nature of USRDS data, center-bias in using rATG vs. IL2i and lack of data on steroid dosage. Results of the present study call for a critical review of induction practices.

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“…32 Gurk-Turner and associates conducted a retrospective cohort study looking specifically at the optimal ATG dose in high-risk kidney transplant recipients in the United States between 2000 and 2005. 33 Patients were considered high risk if they had required retransplants or had a PRA > 40%.…”

Section: Studies Investigating the Optimal Antithymocyte Globulin Dosementioning

confidence: 99%

Untitled

Buttigieg

Julie

Sharma³

et al. 2016

Exp Clin Transplant

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Kidney transplant remains the best type of renal replacement therapy in most patients with end-stage kidney disease, even in those with high immunologic risk. Immunosuppression in these patients is regarded as more complex, owing to the higher risk of both acute and chronic rejection. The advent of induction immunosuppression has resulted in a lower incidence of acute rejection and consequently improved shortterm patient and allograft outcomes. Indeed, the use of these agents, especially in high-risk recipients, has become standard of care at most transplant centers. Transplant physicians are constantly faced with the challenge of estimating the recipients' immunologic risk and tailoring their immunosuppression ac cordingly. This review article aims to provide an up-to-date evaluation of the various studies available, which investigated the use of induction agents in kidney transplant, specifically in high-risk recipients. It evaluates the use of the most frequently used polyclonal antibody (rabbit antithymocyte globulin) versus the less commonly used monoclonal antibody alemtuzumab, superseded agents such as muromonab-CD3, and potentially emerging agents such as rituximab, bortezomib, and eculizumab. With this systematic review, we hope to inform the scientific community and facilitate this controversial decision through the implementation of robust scientific evidence.

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Thymoglobulin and Rate of Infectious Complications After Transplantation

Cited by 35 publications

References 8 publications

Optimal Dose of Thymoglobulin for Induction Therapy in High Risk Kidney Transplant Recipients

Optimal Dose of Thymoglobulin for Induction Therapy in High Risk Kidney Transplant Recipients

Outcomes in African-Americans vs. Caucasians Using Thymoglobulin or Interleukin-2 Receptor Inhibitor Induction: Analysis of USRDS Database

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